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  • A critical appraisal of the methodology and quality of evidence of systematic reviews and meta-analyses of traditional Chinese medical nursing interventions: a systematic review of reviews

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Nursing
Research
A critical appraisal of the methodology and quality of evidence of systematic reviews and meta-analyses of traditional Chinese medical nursing interventions: a systematic review of reviews
  1. Ying-Hui Jin1,
  2. Guo-Hao Wang2,
  3. Yi-Rong Sun1,
  4. Qi Li3,
  5. Chen Zhao3,
  6. Ge Li4,
  7. Jin-Hua Si5,
  8. Yan Li1,
  9. Cui Lu6,
  10. Hong-Cai Shang7
  1. 1Evidence-Based Nursing Center, School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin, China
  2. 2Nursing Department, North China University of Science and Technology Affiliated Hospital, TangShan, China
  3. 3Graduate College, Tianjin University of Traditional Chinese Medicine, Tianjin, China
  4. 4Public Health Department of Tianjin University of Traditional Chinese Medicine, Tianjin, China
  5. 5Library of Tianjin University of Traditional Chinese Medicine, Tianjin, China
  6. 6Emergency Department, Tianjin TEDA hospital, Tianjin, China
  7. 7Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
  1. Correspondence to Professor Hong-Cai Shang; shanghongcai{at}foxmail.com

Abstract

Objective To assess the methodology and quality of evidence of systematic reviews and meta-analyses of traditional Chinese medical nursing (TCMN) interventions in Chinese journals. These interventions include acupressure, massage, Tai Chi, Qi Gong, electroacupuncture and use of Chinese herbal medicines—for example, in enemas, foot massage and compressing the umbilicus.

Design A systematic literature search for systematic reviews and meta-analyses of TCMN interventions was performed. Review characteristics were extracted. The methodological quality and the quality of the evidence were evaluated using the Assessment of Multiple Systematic Reviews (AMSTAR) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) approaches.

Result We included 20 systematic reviews and meta-analyses, and a total of 11 TCMN interventions were assessed in the 20 reviews. The compliance with AMSTAR checklist items ranged from 4.5 to 8 and systematic reviews/meta-analyses were, on average, of medium methodological quality. The quality of the evidence we assessed ranged from very low to moderate; no high-quality evidence was found. The top two causes for downrating confidence in effect estimates among the 31 bodies of evidence assessed were the risk of bias and inconsistency.

Conclusions There is room for improvement in the methodological quality of systematic reviews/meta-analyses of TCMN interventions published in Chinese journals. Greater efforts should be devoted to ensuring a more comprehensive search strategy, clearer specification of the interventions of interest in the eligibility criteria and identification of meaningful outcomes for clinicians and patients (consumers). The overall quality of evidence among reviews remains suboptimal, which raise concerns about their roles in influencing clinical practice. Thus, the conclusions in reviews we assessed must be treated with caution and their roles in influencing clinical practice should be limited. A critical appraisal of systematic reviews/meta-analyses of TCMN interventions is particularly important to provide sound guidance for TCMN.

  • Traditional Chinese Medical Nursing
  • Systematic review
  • Meta-analysis
  • AMSTAR tool
  • GRADE approach

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-011514

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    Footnotes

    • Contributors Y-HJ and H-CS designed the study; G-HW, QL, and Y-RS searched the databases for full-text papers; GL, J-HS, and YL extracted and analysed the data; Y-HJ, CZ, and H-CS performed the critical appraisal; Y-HJ and CL wrote the manuscript, H-CS and J-HS reviewed the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.